Dermatology Flashcards
1
Q
Fitzpatrick Skin Types
A
Fitzpatrick Skin Types
- White
- Never tans - White
- Usually burns - White
- Sometimes burns - Moderate brown
- Rarely burns - Dark brown
- Very rarely burns - Black
- Does not burn
2
Q
Dermatology
- Family histories
A
Dermatology FHx
- Skin disease
- Atopy
- Autoimmune
3
Q
Dermatology
- SHx
A
Dermatology SHx
- Occupation
- Sun exposure
- Contactants - Improvement when away from work
4
Q
Dermatology History
- Drug Hx
A
Dermatology DHx
- Regular/recent
- Systemic/topical
- Where
- How much
- How long
5
Q
Dermatology exam
- SCAM
A
Dermatology SCAM
S - ite
C - colour
A - ssociated changes
M - orphology
6
Q
Dermatology
- ABCD
A
Dermatology ABCD
A - ssymetry
B - order
C - olour
D - iameter
7
Q
Atopic Eczema
- Mx
A
Atopic Eczema - Mx
- Irritiant Avoidance
- Soap/detergents, oveheating/rough clothing
- Infections, pets, pollen, HDM, stress - Emollients
- Topical CSTs
- Daily
- Face more mild than body - Antihistamines
- Pruritus
8
Q
Suspected Melanoma
- Mx
A
Suspected Melanoma
- Refer on urgent pathway if:
- > 3 points
- 2 points for major: Size/shape/colour change irregularity
- 1 point for minor: 7mm/inflammation/oozing/sensation change - Suspected nodular melanoma
- Dermoscopy is suggestive
9
Q
Eczema
- Emmolients
- Role
- Ingredients
- Escalation
A
Emmolients
- Medical moisturisers
- Fats
- eg. paraffin
- and water - Additional antimicrobials
- Rehydrates skin
- re-establishes lipid layer - Lotions-> creams -> ointments
10
Q
Eczema
- Emolient use
- Dosing
- Timing
- Dispenser
- Risks
- Terminating
A
Eczema
- Emolient use
- Liberal and frequent
- BD-QDS - After washing to trap moisture
- Pump dispensers
- Avoid bacteria - Paraffin is flammable
- Continue after flare
11
Q
Eczema steroids
- Escalation
A
Eczema steroids
- Escalataion
- Hydrocortisone
- Euvomate
- Clobetasone butyrate - Betnovate
- Betamethasone valerate - Dermovate
- Clobetalsol propionate
12
Q
Eczema
- Sleep disturbance Mx
A
Eczema Sleep disturbance
- Antihistamines
13
Q
Topical steroids
- Local SEs
A
Topical CSTs
- Local SEs
- Skin atrophy
- Telangiectasia
- Striae
- Acne
- Perioral dermatitis
- Allergic contact dermatitis
- Exacerbate skin infections
14
Q
Topical steroids
- Systemic SEs (PO)
A
Steroid systemic SEs
- Cushing’s
- Immunosuppression
- HTN
- DM
- OP
- Cataracts
- Steroid-induced psychosis
- Fluid retention
15
Q
Topical steroids
- Patient-friendly dosing
A
Topical steroids
- Patient-friendly dosing
- Finger Tip Units
- Eg.
- Face and neck - 2.5 FTUs
- Arm -3FTUs
- Leg - 6FTUs
- Trunk - 7FTUs
16
Q
Eczema
- Maintenance mx
A
Eczema
- Maintenance mx
- Emollients
- Low-potency steroids
- Dressings
- Dry/medicated bandages
- Wet wraps (not for wet eczema)
17
Q
Eczema
- Frequent flare-up management
A
Eczema
- Frequent flare-up management
- Check compliance
- Steroid weekend regime
- Weekly 2/7 of potent steroids - Consider alternatives
- eg. Protopic (Tacrolimus) - Skin swab/nasal swabs
- Bactroban if staph positive - Consider allergic dermatitis
- Immunomoddulators
- eg. Protopic (Tacrolimus)
18
Q
Topical Calcineurin Inhibitors
- 2 Drugs
- 2 Uses
- 3 SEs
A
Topical Calcineurin Inhibitors
- Examples
1. Protopic (tacrolimus ointment)
2. Elidel (pimecrolimus cream) - Use
1. Atopic dermatitis
2. Preventing flare-ups - SEs
1. Local skin irritation
2. Area risk of HSV
3. Worsens acute infections
19
Q
Scalp eczema
- Tx
A
Scalp eczema tx
- Tar-based shampoo
- <18mo, emollient bath oil - Topical steroids (water-based scalp application)
- Betacap
- Sebco ointment for scale removal
20
Q
Dermatology
- Use of methotrexate
- Uses
- Dosing
- SEs
A
Dermatology - methotrexate
- 2 Uses
1. Psorisis
2. Eczema - Dosing
1. PO/SC
2. Folic acid - separate day! - SEs
1. GI upset
2. Mouth ulcers
- Fatigue/anaemia
- Liver
- Lung fibrosis
- BM suppression - screen for infections/live vaccines
- Teratogenic - contraception (male and female!)
- Interactions
- Trimethoprim
21
Q
Methotrexate
- Initiating
- Monitoring
A
Methotrexate
- Initiating
1. Pregnancy test
2. FBC
3. U&E/LFT - Monitoring (2-3 months)
- FBC
- U&E
- LFTs
22
Q
Azathioprine
- Dermatology
- Uses
- SEs
- Screening/monitoring
A
Azathioprine
- Dermatology
- Uses
1. Atopic eczema - SEs
1. BM suppression
2. Allergic reaction
3. GI upset
4. Prolonged use - Skin cancer
- Lymphoma
- Screening/monitoring
1. TPMT test
2. Monitor FBC,LFT,U&E
3. Avoid live vaccines
23
Q
Ciclosporin
- Dermatology
- Uses
- SEs
- Monitoring
A
Ciclosporin
- Dermatology
- Uses
1.Psoriasis
2. Atopic eczema - SEs
1. Gingival hyperplasia
2. GI Upset
3. Fatigue
- Tremor
- Excessive hair growth
- Monitoring
1. No live vaccines
2. No prgenancies
3. No breast feeding
4. Drug interactions
24
Q
Comedonal acne
- First line
- SEs
A
Comedonal acne
- Mx
1st line — Topical retinoid
- Adapelene
- Isotretinoin
+ Benzoyl peroxide - Avoid in pregnancy
- Dries skin and irritates
25
Papular/pustular acne
- Mx
Papular/pustular acne
- Mx
Combination
1. Epiduo
(adapelene +BPO)
2. Duac
(clindamycin +BPO)
26
Refractive acne
- Mx
Refractive acne Mx
- Systemic ABx
1. Tetracycline
- Not in children or pregnancy
2. Macrolides
- Erythromycin/clarythromycin
3. Trimethoprim
- Used in young children
- Some bacterial resistance
4. Primary care
- Stop oral ABx after 3mo
- See dermatologit
27
Female: Moderate-severe acne
- GP Mx
- ADRs
Female acne - moderate-severe
1. Dianette
- Cyproterone acetate
+ ethinyloestradiol
2. Increased risk of VTE
- CI’d in FHx of VTE
- CI’d in past VTE
- Not indicated as sole OCP
28
Acne
- Referal criteria
Acne
- Referal criteria
1. Severe acne
2. Moderate acne
- Partially responsive
- Scarring
- Hyperpigmentation
3. Psychological symptoms
29
Retinoids
- ADRs
Retinoids
- ADRs
1. Dry skin/dry lips/ dry eyes
2. Fragile skin
- Avoid waxing
3. Increased infection risk
4. Slower healing
5. Increased sun sensitivity
6. LFT derangement
- Cholesterol and tri-glycerides
7. Myalgia/arthralgia
8. Depression/DSH/Suicide
9. Teratogenic
- Acitretin (3 years)
30
Psoriasis
- Mx
Psoriasis Mx
- Consider co-morbidities
1. Psoriatic arthritis
- Rheumatology referral
2. CVD
- Drugs
1. Emollients
- Reduce scale
2. Flare-ups
- Vitamin D
eg. Dovobet/Enstilar foam 8-12/52
- Moderate steroid eg. Eumovate 1-2/52
31
Psoriasis
- Vitamin D analogues
1. Names
2. Role
3. SEs
Psoriasis Vitamin D analogues
- Drugs
1. Calcipotriol
2. Tacalitol
3. Calcitriol
- Role
1. Regulate immune system
2. Slow overgrowth
- SEs
1. Irritate sensative areas
2. Hypercalcaemia
3. Not recommended during preganancy.breast feeding
32
Psoriasis
- 2nd line referral
Psoriasis second line
1. Phototherapy
2. Acitretionin
3. Methotrexate
4. Ciclosporin
5. PD4 inhibitor
- Apremilast
6. Dimethyl fumerate
33
Psoriasis
- Phototherapy
1. Timing
2. Types
Psoriasis Phototherapy
- Timing
1. Twice weekly
2. 15-30 treatments
- Types
1. Narrowband UVB
- Severe psoriasis and eczema
2. PUVA (deeper reaching)
- Psorelan +UVA
- Psoriasis, vitiligo, cutaneous T-cell lymphoma
34
Dermatology Phototherapy
- ADRs
Dermatology Phototherapy
- ADRs
1. Redness/discomfort
2. Dry and itchy
3. Folliculitis
4. Poly-morphic light erruption (rash)
5. Cold sores
6. Worsening of skin disease
7. Nausea
- From PUVA psoralen
8. Premature aging/skin cancer
35
Dermatology
- Apremilast
1. Mechanism
2. ADRs
Dermatology - Apremilast
- Mechanism
1. PDE4 i (Phosophodiesterase 4 i)
2. Skin inflammatory processes
- ADRs
1. GI upset
2. Headache/insomnia
3. Tiredness/muscle pain
4. Resp infections
5. Avoid pregnancy/live vaccines
36
Dermatology
- Dimethyl fumerate (fumaric acid)
1. Mechanism
2. SEs
Dimethyl fumerate (fumaric acid)
- Mechanism
1. FAE acts on immune system
- SEs
1. GI upset
2. Headache
3. Flushing
4. Monitor LFT, U&E, urine dip, FBC
- Leukoencephalopathy
5. Avoid pregnancy/breastfeeding
37
Psoriasis
- Biologics
1. Use
2. Names
3. SEs
Psoriasis Biologics
-Use
1. Methotrexate and ciclosporin no effect/tolerated
2. Large impact disease
- Drugs
1. Ustekinumab
2. Adalimumab
3. Secukinumab
4. Infliximab
- SEs
1. TB/Hep BC/HIV/ VZV screen
2. No live vaccines
38
Scalp psoriasis
- Mx
Scalp psoriasis
- Mx
1. Potent CSTs
- Betacap 4 weeks
2. Descaling
- Diprosalic
3. Potent CTs with Calcipotriol
- Dovobet 4 weeks
4. Very potent CST
- Etrivex shampoo 4 weeks
- Sebco scalp ointment OD/BD
39
Venous ulcer
1. Sx
2. Mx
Venous ulcer
- Sx
1. Well defined, below knee
2. Brown edges, granulation tissue
3. Itchy
- Mx
1. Compression stockings
- Check ABPI with doppler
40
Nail dystrophy
- Causes
Nail dystrophy
- Causes
1. Melanoma
2. Trauma
3. Fungal infection
4. Psoriasis
41
Melanoma
- Prognostication
Melanoma
- Prognostication
- Breslow thickness
42
Tinea pedis
- common organism
- Treatment
Tinea pedis
- common organism
Trichophyton rubrum
- Treatment
Fluconazole
43
Perioral dermatitis
- Distribution
- Treatment
Perioral dermatitis
- Distribution
1. Tiny blisters
- red, itchy
- tingle, burn
2. Muzzle area
(Triggered by steroids)
- Treatment
1. Stop using cleanses/steroids
2. Non steroids
- Elidel cream (Pimecrolimus)
- Minocycline
44
SCC
- Poor prognosis sites
SCC
- Poor prognosis sites
1. Lips
2. Ears
3. Eyes
45
Bullous pemphigoid
- Blisters
- Treatment
Bullous pemphigoid
- Blisters
Tense
Some empty
- Treatment
0. Autoimmune condition
1. Topical Steroids (Dermovate)
2. Doxycycline
3. Prednisolone (0.5mg/kg)
- until no new blisters
46
High dose steroids
- protection
High dose steroids
- protection
1. PPI
2. Steroid card
- COVID warning
3. Bone protection
47
Psoriasis
- appearance
- treatment
Psoriasis
- appearance
0. Demarcated scaly plaques
1. Extensors
2. Ears
3. Scalp
4. Natal cleft
5. Nail pitting
- treatment
1. Retinoids
48
Lesions
- 5 Ss
Lesions
- 6 Ss
1 Site
2 Shape
3 Size
4 Shade
5 Surface
6 Surrounding skin
49
Acne
- Combination gels
Acne
- Combination gels
1. Duac
- BP
- Clindamycin
2. Epiduo
- BP
- Adapalene (retinoid)
50
Roaccutane
- ADRs
Roaccutane (Isotretinoin)
- ADRs
1. Dry eyes, skin, nose
- Thin and breakable
2. Sore throat/mouth
3. Headaches
4. Teratogenic
- COCP
5. Low mood
51
Eczema
- Mx ladder
Eczema
- Mx ladder
1. Emollients
2. Topical csts
(mild, mod, potent)
3. Topical calc. i.
- Tacrolimus/pimecrolimus
4. Bandages
5. Phototherapy
6. Oral CSTs
52
Psoriasis
- Common Types
Psoriasis
- Types
1. Plaque
- psoriasis vulgaris
2. Scalp psoriasis
3. Nail psoriasis
4. Guttate psoriasis
- <1cm on trunk, limbs scalp
- Post strep
5. Inverse psoriasis
- flexural
53
Psoriasis
- Four less common types
Psoriasis
- Four less common types
1. Pustular psoriasis
2. Generalised pustular psoriasis
- Von Zumbusch psoriasis
3. Palmoplantar pustulosis
4. Erythrodermic psoriasis
- Nearly all the skin
54
Lentigo maligna
- Features
- Tx
Lentigo maligna
- Features
1. Slow growing brown patch
2. Evolves into melanoma
3. Commonly on the face
4. Commonly on older people
55
Nodular melanoma
- Mx
Nodular melanoma
- Mx
Stage 0
- Consider Imiquimod
- 0.5cm margin excision
- Repeat bipsy
Stage 1
- 2cm margin excision (1 if disfiguring)
Stage 2
- 2cm margin excision
Stage 3
- Excision
- Adjuvant chemo
- No adjuvant radio unless risk outweighs harms
Stage 4
- MDT
- Surgery/ablation
- Brain surgery/radio
- Consider chemo/immnotherapy
(Nivolumab/ipilimumab)
56
Acral melanoma
- Features
Acral melanoma
- Features
1. Palms, soles, fingernails/toenails
2. Common in darker skin
57
Sub-ungal haematoma
- Features
- Mx
Sub-ungal haematoma
- Features
1. Pseudo hutchinson's sign
2. Subungal blood
- Mx
1. Follow up
58
Benign longitudinal melanonychia
- Features
- Mx
Benign longitudinal melanonychia
- Features
1. Thin
2. Multiple
- Mx
1. Biopsy to r/o melanoma
59
Classic seborrheic keratoses
- Features
- Mx
Classic seborrheic keratoses
- Features
1. Brown 'warty' appearance
- comedo-like openings
2. Milea-like cysts
3. Older person
4. Multiple similar lesions
5. Rough to touch
60
Non-melanoma skin cancer
- Two pre-malignant conditions
Non-melanoma skin cancer
- Pre-malignant conditions
1. Actinic keratosis
2. Bowen's disease
- Pink patch
- Full thickness dysplasia
- In situ SCC
61
BCC
- Appearance
- Growth
- Ex
BCC
- Appearance
1. 'Rodent ulcer'
2. Rolled pearly margin
- Translucent stroma production
- Well defined blood vessels
3. Morphoeic BCC
- indistinct edges
4. Superficial BCC
- Pink patch
- Similar to Bowen's disease
5. Pigmented BCC
- Grey 'bean-like' structure
6. Slow growing
- Growth
1. Destruction
2. Can wrap around nerve
- death from brain metastasis
- Ex
1. Good lighting and remove crust
62
MOHS
- Sites
- Process
MOHS
- Sites
1. Sensitive
2. Narrow margin
- Process
1. LA
2. Horizonal cut
3. Frozen section
4. Margins - peripheral and deep
63
Picker's Nodule
- Features
- Mx
Picker's Nodule
- Features
1. Intensely itchy
2.
- Mx
1. Psychiatry
2.
64
Dermatofibroma
- Features
- Mx
Dermatofibroma
- Features
1. May mimic bcc, scc, melanoma
2. Firm nodules
3. Dimple sign
- Pinch - and see dimple in the middle
- Mx
1. Observe
65
SCC
- Features
SCC
- Features
1. 1/5 Type 1,2 skin
2. Can be painful
3. Keratotic nodule
4. Fleshy - can be ulcerated
5. Rapidly growing
6. Sun-exposed locations
- Ear helix
- Hand
- Actinic keratosis
66
arSCC
- Mimics
SCC
- Mimics (biopsy them)
1. Viral warts
- inflamed squamous papillomas
- Keratin horn
- Painless and pruritis
2. Regressing keratocanthoma
- Painless
- Ulcerated
- Crateriform
3. Sebhorric keratosis
- Large
- Traumatised
- Inflammed
4. Lymphoedema nodule
- Granulation tissue
- Fluid
5. Giant comedone
67
Skin cancer
- Topical options
Skin cancer
- Topical options
1. 5FU (Efudix)
- AK, Bowen's disease
2. Diclofenac
- AK
3. Imiquimod (Aldara)
- Superficial BCC
4. Retinoids
68
Surgical excision options
Surgical excision options
1. Standard wide excision
- pre-determined margins
2. MOHS
- Micrographic excision
- Layer by layer with staged mapping
69
Skin cancer
- Non-surgical procedures
Skin cancer
- Non-surgical procedures
1. Photodynamic therapy (PDT)
- Photosensitiser attaches to dysplastic cells
- Shine a light
- Photosensitiser destroys cells
2. Cryotherapy
- Superficial lesions
- SK to AK, Bowen's and Superficial BCC
70
Skin cancer
- Radiotherapy uses
Skin cancer
- Radiotherapy uses
1. Older persons
- SCC (good response)
- BCC (less good response)
71
Metastatic skin cancer
- Systemic treatment
Metastatic skin cancer
- Systemic treatment
1. Immune therapy
72
Sun behaviour
- Incl sun screen
Sun behaviour
- Incl sun screen
1. Avoid sun
2. Sunscreen
- 15-30 minutes before exposure
- 2-hourly reapplication
- 30mls + for adults
3. SPF
- 4 - 75% blockage
- 15 - 93% blockage
- 30 - 96% blockage
73
Actinic keratosis
- 5-FU/Imiquimod treatment progress
Actinic keratosis
- 5-FU/Imiquimod treatment progress
1. Application
2. 1-2 weeks later eruption
3. 6-7 weeks later recovery
74
Cryosurgery
- Process
Cryosurgery
- Process
1. Liquid nitrogen
(-196ºC)
2. Ice crystals form
75
Skin cancer
- Surgical principles
Skin cancer
- Surgical principles
1. Remove all cancer
- Prevent metastatic spread
2. No biopsies
3. Wide-local excision
- 2mm margin where possible
- fully excised
- 3-1 ratio for elipse
- scar longer than patient expects
76
Pre-determined margins
1. Melanoma
2. SCC
3. BCC
Pre-determined margins
- Melanoma
1. In situ (5mm)
2. <1mm thickness (1cm)
3. >2mm thickness (2cm)
- SCC
4. 4-8mm
- BCC
5. 3-5mm
- Suspicious pigmented lesion
6. 2mm
77
Superficial spreading malignant melanoma
- Features
- Mx
Superficial spreading malignant melanoma
- Features
- Mx
78
Skin cancers
- 1 Key fact for diagnosis
- 2 Powerful risk factors
Skin cancers
1 Key fact for diagnosis
- Onset and rate of growth
2 RFs
- Sun exposure
- Genetics
79
Cancer layer origins
- BCC
- SCC
- Melanoma
Cancer layer origins
- BCC
1. Basal epidermis
- SCC
2. Epidermal squamous
- Melanoma
3. Epidermis
80
Skin cancer
- Proportions and referrals
1. 2WW
2. Routine
Skin cancer
- Proportions and referrals
1. 2WW
- 10% melanoma
- 30% SCC
2. Routine
- 60% BCC
81
Melanoma
- Breslow and prognosis
Melanoma
- Breslow and prognosis
1mm - 100% 5YS
4mm - 60% 5YS
82
BCC
- Demoscopy signs
BCC
- Demoscopy signs
1. Telangiectasia
- Tree-like trunky red vessels
83
Basal cell c
- Subtypes
Basal cell c
- Subtypes
1. Superficial spreading BCC
- Patch
2. Nodular BCC
3. Infiltrative/Scar-like BCC
84
BCC Treatments
- Non-surgical
- Surgical
BCC Treatments
- Non-surgical
1. Cryotherapy
- Superficial BCC
- 99% 5 year cure
- Liquid nitrogen
- 20s, 30s gap, 20s
2. Creams
- 5FU
- Imiquimod
3. PDT
- Sensitising cream
- Red light
4. Radiotherapy
- Surgical
1. Curettage and cautery (24%)
- 90% cure
2. Excision (58%)
- 4-5mm margin
- <2% recurrence
85
SCC
- Dermoscopy
SCC
- Dermoscopy
1. Keratin Patch
86
SCC
- Followup
1. Low risk
2. High risk
SCC
- Followup
1. Low risk
2. High risk
- 4-6 mo
- Lymphadenopathy
87
Melanoma
- most common age groups
Melanoma
- most common age groups
- 38% 45-65
- 20% 65-75
88
Benign lesions
- Features
Benign lesions
- Features
- Symmetry good
- Border regular
- Colour uniform
- Diameter (vague) >6mm
- Evolution
89
Melanoma
- Dermoscopy
Melanoma
- Dermoscopy
1. Dysplastic colour
90
Melanoma
- Acral
- Lentigo
Melanoma
- Acral
1. Palms/soles
2. Eg. Sub ungual
- Lentigo
1. Face/sun touched
91
Melanoma
- Margin paradox
Melanoma
- Margin paradox
1. 2mm
2. Further surgery with lymph nodes
- eg. 2cm
92
Melanoma
- Immunotherapies
Melanoma
- Immunotherapies
1. IL2
- interferon alpha
2. Nivolumab
Imatinib
93
Melanoma
- Followup
Melanoma
- Followup
1. Superficial
- 1 year
2.
94
Comedone
- Definition
Comedone
- Definition
1. Plug in sebaceous follicle
2. Contains
- sebum
- bacteria
- cellular debris
3. Open (blackhead)
- Closed (whitehead)
95
Dermatology
- Distributions
Dermatology
- Distributions
1. Generalised
- All over the body
2. Widespread
3. Localised
- One area only
4. Flexural/extensor
5. Pressure areas
- sacrum, buttocks
- ankles, heels
6. Dermatomal/photosensative
96
Dermatology
- Koebner phenomenon
Dermatology
- Koebner phenomenon
1. Site of trauma
2. Linear erruption
97
Lesions
1. Target
eg.
2. Annular
eg.
Lesions
1. Target
- Concentric circles
eg. erythema multiforme (immune eg. HSV)
2. Annular
- Circle/ring
eg. tinea corporis (ringworm)
98
Lesions
- Discoid/nummular
1. Description
example
- Discoid/nummular
1. Round lesion/coin-shaped
2. Discoid eczema
3. Hypopigmentation in SLE
99
Erythema
- Pathophysiology
Erythema
- Pathophysiology
1. Inflammation
2. Vasodilation
100
Purpura
1. Pathophysiology
2. Types
Purpura
1. Pathophysiology
- bleeding into skin
- bleeding into mucous membrane
- non-blanching
2. Types
- petechiae
- ecchymoses
101
Hypo-pigmentation
- Definition
- Example
Vitiligo
- Definition
- Example
Hypo-pigmentation
- Definition
1. Paler skin areas
- Example
1. Pityriasis versicolor (superficial fungus)
Vitiligo
- Definition
1. Absence of melanin
- Example
2. Vitiligo (loss of melanocytes)
102
Hyper-pigmentation
- Broad Differentials
Hyper-pigmentation
- Broad Differentials
1. Post-inflammatory
2. Melasma
3. Naevi
103
Melasma
- Pres
- Tx
Melasma
- Pres
1. Hormonal
2. UV
3. Malar region of darker skin
- Tx
1. Retinoids (bleaching)
2. Bleaching/chemical peels
3. Laser/light therapy
4. Sun protection
104
1. Macule
- definition
- example
2. Patch
- definition
- example
1. Macule
- Flat area of altered colour
- eg Freckles
2. Patch
- Larger flat area of altered colour or texture
- eg vascular malformation (naevus flammeus/PW stain)
105
Raised lesions
- Papule
- Nodule
- Plaque
+examples
Raised lesions
1. Papule
- Solid raised lesion
+ xanthomata
2. Nodule
- Solid raised lesion with deeper component
+ Pyogenic granuloma (telangiectaticum)
3. Plaque
- Palpable scaling raised lesion
+ Psoriasis
106
1. Vesicle
2. Bulla
3. Pustule
4. Abscess
1. Vesicle
- Raised clear filled lesion
+ Acute hand eczema
2. Bulla
- Raised, clear filled lesion
+ Insect bite reaction
3. Pustule
- Pus-filled lesion
+ Acne
4. Abscess
- Localised accumulation of pus
+ Peri-ungal abscess (paronychia)
107
1. Boil/furuncle
2. Carbuncle
1. Boil/furuncle
- Around/within follicle
- Staph infection
2. Carbuncle
- Adjacent hair follicles
- Staph infection
108
1. Excoriation
2. Lichenification
1. Excoriation
- Trauma to epidermis
+Eczema
2. Lichenification
- Roughening of skin with markings
+ Chronic eczema
109
1. Scales
2. Crust
1. Scales
- Flakes of stratum corneum
+ Psoriasis (silvery scales)
2. Crust
- Rough surface through epidermis
- Serum, blood, bacteria, debris
+ impetigo
110
1. Ulcer
2. Fissure
1. Ulcer
- Loss of epidermis and dermis
- Heals with scar
2. Fissure
- Epidermal crack
+ Dryness/eczema
111
1. Scar
2. Striae
1. Scar
- New fibrous tissue
- post-healing
+ keloid scar
2. Striae
- Linear area
- Purple -> Pink -> White
- Scar-like
+Steroid use/ growth /pregnancy
112
Scar
- Three classifications
Scar
- Three classifications
1. Atrophic
- thinning
2. Hypertrophic
- within wound boundary
3. Keloidal
- beyond wound boundary
113
Hirsuitism vs Hypertrichosis
Hirsuitism vs Hypertrichosis
1. Androgen dependent hair-growth
- in a female
2. Non-androgen dependent
- eg. pigmented naevi
114
Nails
1. Clubbing
2. Koilonychia
3. Onycholysis
4. Pitting
Nails
1. Clubbing
- Loss of angle
- Posterior nail fold and nail plate
2. Koilonychia
- Spoon-shaped depression
3. Onycholysis
- Separation of distal end from nail bed
- Trauma, psoriasis, fungal, hyperthyroid
4. Pitting
- Punctate depressions
- Psoriasis, eczema, alopecia
115
Skin
- Skin appendages
Skin
- Skin appendages
1. Hair
2. Nails
3. Sebaceous glands
4. Sweat glands
116
Skin
- Four cell types
- Cell functions
Skin cells
1. Keratinocytes
- Keratin barrier production
2. Langerhans'
- Antigens and T-Cell activation
3. Melanocytes
- Melanin UV protection
4. Merkel
- Nerve endings for sensation
117
Epidermis
- Layers
Epidermis
- Layers
1. Basale
- Dividing cells
2. Spinosum
- Differentiating cells
3. Granulosum
- Keratohyalin + lipid
4. Corneum
- Keratin
118
Skin layers
- Sole and Palm
Skin layers
- Sole and Palm
1. Lucidum
- Pale, compact keratin
2. Beneath Corneum
119
Dermis
- Main cell type
- Main proteins
Dermis
- Main cell type
1. Fibroblasts
2. Immune and appendages
3. Connective tissues
- Main proteins
1. Collagen (mainly)
2. Elastin
3. Glycosaminoglycans
120
Hair
- Three types
- Three growth cycles
Hair
- Three types
1. Lanugo (fetus)
2. Vellus (fine short)
3. Terminal (coarse long)
- Three growth cycles
1. Anagen (long; growth)
2. Catagen (short; regression)
3. Telogen (Resting; shedding)
121
Sebaceous glands
1. Secretion
2. Stimulation
3. Pathologies
Sebaceous glands
- Secretion
1. Sebum
2. Pilosebaceous unit
- Stimulation
1. Dihydrotestosterone from androgens
2. Starts at puberty
- Pathologies
1. Sebum and bacterial colonisation
2. Gland hyperplasia
122
Sweat glands
1. Stimulation
2. Types
3. Pathologies
Sweat glands
- Stimulation
1. Sympathetic nervous system
- Types
1. Eccrine
- Universal
2. Apocrine
- Puberty onwards
- Axillae, areolae, genitalia, anus
- Bacterial action produces body odour
- Pathologies
1. Apocrine inflammation/infection
- Hidradenitis suppurativa
2. Eccrine overactivity
- Hyperhidrosis
123
Wound healing
- Stages
Wound healing
- Stages
1. Haemostasis
- Vasoconstriction
2. Inflammation
- Vasodilation
3. Proliferation
- Granulation tissue
- Angio-genesis
- Re-epithelialisation
4. Remodelling
- Collagen fibre re-organisation
- Scar maturation
124
Erythema nodosum
- Presentation
Erythema nodosum
- Presentation
- Hypersensitivity Response
1. Shins, most commonly
2. Discrete tender nodules
- May become confluent
3. Lesions appear for two weeks
- Bruise-like discolouration on resolution
125
Erythema nodosum
- Causes
1. Infection
2. Inflammation
Erythema nodosum
- Hypersensitivity Response
- Infection
1. Group A Strep
2. TB
3. Chlamydia
4. Leprosy
- Inflammation
1. Pregnancy
2. Malignancy
3. IBD
4. Sarcoidosis
126
Acute skin management
1. Principles for:
- Erythema multiforme
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
2. Complications
1. Erythema multiforme
2. Stevens-Johnson Syndrome
3. Toxic Epidermal Necrolysis
- Management principles
1. Early recognition
2. Full supportive care
- Complications
1. Mortality rates 5-12% SJS, >30% TEN
2. Sepsis
3. Electrolyte imbalance
4. Multi-system organ failure
127
Acute Skin Conditions
- Presentations
1. EM
2. SJS
3. TEN
Acute Skin Pathologies
1. Erythema multiforme
- Often unknown/Herpes Simplex/Drugs
- Acute self-limiting
- Mucosa limited to one surface only
2. SJS
- Muco-cutaneous necrosis
- At least two mucosal sites
- Limited or extensive skin involvement
3. TEN
- Drug-induced
- Extensive skin/mucosal necrosis
- Systemic toxicity
- Full thickness epidermal necrosis
- Sub-epidermal detachment
128
Erythema multiforme
- Presentation
Erythema multiforme
- Presentation
1. Erythematous patches
- Evolving into target lesions
2. Often involves both hands
129
SJS
- Early Symptoms
SJS
- Early Symptoms
1. Fever
2. Flu-like symptoms
3. Blistering
130
Acute Meningococcaemia
- Rash progression
Acute Meningococcaemia
- Rash progression
1. Blanching maculo-papular rash
2. Non-blanching purpuric rash
3. Progression to ecchymoses
- Haemorrhagic bullae
- Tissue necrosis
131
Acute meningococcemia
- Close contact prophylaxis
Acute meningococcemia
- Close contact prophylaxis
1. ABx
- Rifampicin
132
Erythroderma
- Causes
- Management
Erythroderma
- Causes
1. Skin disease (eczema/psoriasis)
2. Lymphoma
3. Drugs
- Sulfonamides
- Gold
- Penicillin
- Allopurinol
- Captopril
4. Idiopathic
- Management
1. Underlying
2. Emollients and wet-wipes
3. Topical steroids
133
Eczema Herpeticum
- Pathology
- Presentation
- Management
Eczema Herpeticum
(Kaposi's varicelliform eruption)
- Pathology
1. Atopic eczema or other exacerbation
2. Herpes simplex cause
- Presentation
1. Widespread eruption
2. Crusted papules
3. Blisters and erosions
- Management
1. Anti-virals (aciclovir)
2. Antibiotics for 2º infections
134
Necrotising fasciitis
- Causes
- Presentation
- Mx
Necrotising fasciitis
- Causes
1. Group A Strep
2. Anaerobes or aerobes
3. RFs - Abdo surgery/co-morbidities
- Presentation
1. Severe pain
2. Erythematous, blistering, necrotic skin
3. Systemic illness
4. Surgical crepitus/soft tissue gas
- Mx
1. Urgent surgical referral
2. IV ABx
135
Erysipelas & Cellulitis
- Pathology
- Causes
-Management
Erysipelas & Cellulitis
- Pathology
1. Dermis and upper sub-cutaneous
- Erysipelas
2. Deep sub-cutaneous tissue
- Cellulitis
- Causes
1. Strep pyogenes
2. Staph a.
3. RFs: Immunosuppression, wounds, leg ulcers
-Management
1. ABx
- Fluclox/benpen
2. Supportive
- Elevation, dressings, analgesia
136
'Scalded Skin' Syndrome (staph)
- Pathology
- Presentation
- Mx
'Scalded Skin' Syndrome (staph)
- Pathology
1. Epidermolytic toxin
2. Ben-pen resistant staph (coag positive)
- Presentation
1. Infancy/childhood
2. Scald-like skin
- Large flaccid bullae
- Perioral crusting
- Intra-epidermal blistering
3. Painful lesions
- Mx
1. Recovery in 5-7 days
2. ABx
eg. Resistant penicillin, erythromycin, cephalosporin
3. Analgesia
137
Fungal infection
- Site classifications
Fungal infection
- Site classifications
1. Tinea Capitis
- Scalp ringworm
2. Tinea Corporis
- Itchy, circular/annular lesions
3. Tinea manuum
- Palmar scaling/dryness
4. Tinea unguium
- Nail discolouration, thickening, crumbling
5. Tinea cruris
- Groin and natal cleft
6. Tinea pedis
- Athlete's foot
7. Tinea incognito
- Tinea treated inappropriately with steroids
8. Tinea versicolor/Pityriasis
- Upper trunk scales
- Malessezia furfur
138
Skin
- Fungal infection mx
Skin
- Fungal infection mx
1. No steroids
- Tinea incognito
2. Topical agents
- terbinafine cream
3. Oral agents
- severe/widespread/nail
- itraconazole
139
Atopic eczema/dermatitis
- Causes
Atopic eczema/dermatitis
- Causes
1. Primary genetic defect
- skin barrier function
2. Filaggrin protein loss of function
3. Exacerbating factors
- infections
- allergens
- sweating, heat, occupation, severe stress
140
Eczema
- Presenting morphology
1. Acute
2. Chronic
3. Papular
Eczema morphology
- Acute
1. Itchy papules
2. Vesicles
- Chronic
1. Dry scaly patches
2. Erythematous or grey/brown
3. Lichenification
- Papular/follicular
1. Brown, grey, purple bumps
141
Phototherapy
- dosing units
Phototherapy
- dosing units
1. J/Cm2
142
Pyoderma gangrenosum
- Aetiology
- Pres
- Mx
Pyoderma gangrenosum
- Aetiology
1. Autoimmune
- Common in RA
2. Discrete ulcers
Oedematous, violaceous border
3. Topical potent steroids
- betnovate
- demovate
- Cyclosporin/cyclophosphamide
143
Punch biopsy
- Size
- Examples
Punch biopsy
- Size
1. <3mm
2. Full thickness
- dermis
- Examples
1. AK
2. Pyoderma gangrenosum
144
Cyclosporin
- 5 Hs
Cyclosporin
- 5 Hs
1. Hypertension
2. Hyperkalaemia
3. Hypertrichosis
4. Hair loss
5. Hypertrophy of gingiva
145
Shave biopsy
1. Type
2. Uses
Shave biopsy
1. Type
- Scooping flat lesions
2. Uses
- Flat lesions
146
Incisional biopsy
- Type
- Uses
Incisional biopsy
- Type
1. Deep incision
- Uses
1. Vascular structures
2. Not commonly used
147
Excision biopsy
1. Type
2. Uses
Excision biopsy
1. Type
- Curative eg for skin cancers
2. Uses
- SCC
- BCC
- Melanoma
148
Breslow Thickness
1. Epidermis
2. Dermis
3. Hypodermis
Breslow Thickness
1. Epidermis
- No stage (0)
- In situ melanoma
( - Bowen’s disease in SCC)
2. Dermis
- Depth of >1mm - 1cm margin
2-4mm - 1-2cm margin
4mm - 2 cm margin
3. Hypodermis
149
Melanoma
- Staging Ix
- Mx
Melanoma
- Staging Ix
1. Staging CT
2. PET CT
- Mx
1. Surgery
2. Immunotherapy
3. (Chemo-radio not useful)
150
Rosacea
- Types
- Pathology
Rosacea
- Types
1. Papulopustular
2. Rhino-phimatous
- Pathology
1. Vasodilatation
151
Papulopustular Rosacea
1. Tx
Papulopustular rosacea
1. Tx
- Metronidazole
- Oxytetracicline (3-6 mo)
- 15-20% Azelaic acid
- Topical Ivermectin (anti-fungal and anti-biotic)
152
Psoriatic arthritis
- Joint pattern
Psoriatic arthritis
- Joint pattern
- DIPJ
153
Acne in pregnancy
1. Retinoids
Acne in pregnancy
1. Oral and topical retinoids are highly teratogenic
- 6-12 mo course
- HCG test and LFTs too
2. High dose salicylates and hydroquinone also not used
3. Low dose Azelaic acid is allowed
154
Potent topical corticosteroids
- Length of course
Potent topical corticosteroids
- Length of course
1. 8 Weeks max
155
Psoriasis
- Treatment ladder
Psoriasis
- Treatment ladder
1. Topical CST + Top D analogue
- Enstella
2. Top Vit D Analogue BD
3. Top CST + Coal tar OD
4. Dithranol + Dermatology
- Black liquid to soak plaques
- eg. PUVA and PUVB (immunosuppressive)
156
Guttate psoriasis
- Signs
- Pathology
Guttate psoriasis
- Signs
1. Raindrop lesions
2. Small scaly patches
- Pathology
1. Post-viral/strep
157
Pitoriasis rosacea
- Signs
- Pathology
Pitoriasis rosacea
- Signs
1. Fur tree sign
2. Herald patch
- Pathology
1. Post-viral
158
Topical steroid course
1. Body
2. Scalp
Topical steroid course
1. Body
- 8 weeks
2. Scalp
- 4 weeks eg. Betnovate
159
Actinic keratosis
- Creams
Actinic keratosis
- Immunotherapy Creams
- Skin will get yellow, crusty, and peel
1. Aldara
- Contains imiquimod
2. Effedex
- Contains 5FU
160
Mohs surgery
- Indications
- Technique
Mohs surgery
- Indications
1. Delicate places
2. Visible places
3. Less disfiguring
- Technique
1. Checking under microscope
2. Returning to surgery
3. Repeat
161
Which virus is associated with Bowen’s disease?
Which virus is associated with Bowen’s disease?
1. HPV 16&18
162
Signs
1. Gottron’s
2. Kernig
3. Nikolsyiy
4. Aspitz
5. Koebner
Signs
1. Gottron’s
- Dermatomyositis on knuckles
2. Kernig
- meningitis
3. Nikolsyiy
- Flacid bullous desquamation
4. Auspitz
- Pin-point bleeding on psoriasis
5. Koebner
- Psoriasis at site of trauma
